All India Institute of Medical Sciences, New Delhi
Abstract
Tuberculosis is different in children. It involves many
organs, instead of being the predominantly respiratory
disease that it usually is in adults. Fortunately, it readily
responds to treatment–if you diagnose it early enough
and treat it for long enough! This is the problem. Unfortunately,
tuberculosis causes such non-specific
symptoms and signs, and you are so seldom able to isolate
bacilli, that you may never be sure of the diagnosis. Even
experts sometimes disagree. In India particularly, it is a
disease of the poorest of the poor, but even in them it
causes only a small proportion of their burden of morbidity.
The great problem is to reach those infected.
Of every thousand Indians, seven children and about
twenty adults have active tuberculosis, and five of these
adults are sputum positive. Only about half the 9 million
in the community at any one time are ever diagnosed, and
of these only about 13% complete their treatment, so
there is a huge pool of infectious cases, half a million of
whom die each year. Fortunately, the incidence of tuberculosis
among children reporting to hospital is slowly
decreasing, probably largely due to improved coverage
with BCG
